Saline implants under the muscle for 25 years and have capsular contracture (grade 3) on one side. Chance of reoccurance?

Question

Is the reoccurrence rate of another cc high and if I explant and decide later to re implant-is that surgery more complicated?

Emre Guvercin, MD, FEBOPRAS · Answer

After 25 years with saline implants, developing a Baker Grade III capsular contracture on one side is not unusual, and fortunately it does not mean you are destined to develop another contracture after revision. The risk of recurrence depends largely on the surgical strategy, implant type, implant pocket, and individual healing characteristics. In general, recurrence rates are higher after simple capsule release alone and lower when a more comprehensive revision is performed, such as capsulectomy with implant exchange and optimization of the implant pocket.If you choose to explant now and re-implant later, that is certainly possible. The delayed re-augmentation procedure can be somewhat more complex because the tissues, capsule, and implant pocket may change after explantation, but experienced breast surgeons perform these staged procedures regularly. The complexity depends on how much breast tissue remains, skin quality, and whether a lift is needed at the time of explant or re-augmentation.
One important consideration is that if you explant and decide not to replace the implants immediately, many patients benefit from a Push-Up Lift at the time of explantation to reshape and support their own breast tissue. This preserves aesthetics while keeping future augmentation options open. If implants are reintroduced later, they can be placed into a more favorable and stable breast envelope.
Overall, while there is always some risk of recurrent capsular contracture after re-implantation, it is not necessarily high, and a well-planned revision can significantly reduce that risk. The decision between immediate exchange, explant alone, or staged re-augmentation should be based on your goals, tissue quality, and comfort with future surgery.

Gary M. Horndeski, MD · Answer

Once you have a capsular contracture then it is more likely that you will continue to have a capsular contracture if implants are placed again. What I recommend to you is explantation, waiting 3-6 months and then consider new implants placed in a different pocket.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Daniel Barrett, MD · Answer

Dear alicewo,

capsular contracture happens. In fact, every implant has a capsule form around it, its just a certain percentage develop thick capsules. There is a lot we don't know about it actually. Some think that bacteria that gets on the implant during insertion can increase the risk. Thats why we use a Keller Funnel in our practice to reduce that possibility. Our capsular contracture rate is less than 2% because we use a keller funnel as well as meticulous operating room techniques.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Carlos Alberto Ríos García, MD · Answer

After 25 years with saline implants, developing a grade 3 capsular contracture on one side is unfortunately not uncommon. Over time, the body can progressively thicken and tighten the capsule around the implant, leading to firmness, distortion, asymmetry, and discomfort.
The reassuring part is that capsular contracture can usually be treated successfully. However, there is always some possibility of recurrence because the body naturally forms scar tissue around any implant.
The recurrence risk depends on many factors, including:
* your healing tendency* implant age* implant placement* chronic inflammation or biofilm* surgical technique* implant type* and whether the capsule is fully or partially removed
In general, recurrence is possible, but many patients do very well for years after revision surgery, especially when the underlying causes are addressed carefully.
If you choose explantation now and later decide to re-implant, yes, the surgery can become somewhat more complex because:
* tissues may thin over time* scar tissue changes the anatomy* the pocket may contract or shift* and additional support or reconstruction techniques may sometimes be needed
That said, delayed re-augmentation is still commonly performed and can often be done safely in experienced hands.
In our practice, we frequently evaluate patients with long-standing implants and capsular contracture, and one of the most important decisions is determining whether your goals are best achieved with:
* implant exchange* total capsulectomy* explant alone* staged reconstruction* or delayed re-augmentation later on
There is not one single correct answer for every patient. The best choice depends on your anatomy, symptoms, tissue quality, and long-term goals.

Frank Agullo, MD · Answer

Your twenty-five year run on submuscular saline breast implants will more likely end the way it has with most other women, and a grade III capsule on one side at some point is probable. Recurrence rates vary based on what transpires in the operating room. Ideally a total capsular resection should be done on the affected side, with the pocket switched to a neo-subpectoral or fresh dual plane on clean tissue, and reinforcement along the lower pole with a GalaFlex Lite or ADM. With those interventions in place, recurrence drops into the single digits in most series I trust. Placing a new implant back inside the old scarred pocket without changing the plane is essentially playing the lottery.

About your second question, yes, separating explantation now from a later re-implantation will result in a more difficult second surgery than a one-stage exchange. The pocket scars down on you, the soft tissues thin while the breast sits unsupported, and a small fat graft is often added at the later session, possibly with a breast lift, to prepare the area before a new implant fits well.

One-stage versus staged depends on the photos taken in a consultation.

#StayBeautiful,

@RealDrWorldWide

Ira H. Rex III, MD · Answer

The answer to your first question is generally yes, higher than the chance of you getting your first contracture.  This is an issue that you really have to discuss with your plastic surgeon.  If you decide to remove your implants, it usually is not much more difficult for the surgeon to place implants in the future.

Leland Deane, MD, FACS · Answer

Without knowing more specifics, the chance of repeat capsular contracture is higher if already present. You're in a good position, however, to remove the implants completely and let the situation resolve. The good thing is that the capsular tissue will soften without the implant present, so capsule removal is usually not needed. I'm happy to answer more questions virtually. Best of luck.

Waylon Zeng, MD · Answer

Hi there, thank you for your question. Capsular contracture risk is hard to predict in patients, but patients who have had cap con in the past are at higher risk of developing it again with subsequent implant placements. There are ways we can reduce the chances of it forming again, such as using mesh and changing the pocket. Certain implants such as Motiva silicone implants have lower rates of developing it due to its implant shell technology. Unfortunately, there is no way to know for sure with revision patients!

Camille Cash, MD · Answer

It's not alarming to develop a capsular contracture after having your implants for over 25 years.  There is a chance of recurrence on a future augmentation and that risk cannot be eliminated completely.  There are many steps that I take as a board certified plastic surgeon to keep the risk of developing a capsular contracture low for my patients.  It is generally not an issue to explant and then re augment at a future date.

Saline implants under the muscle for 25 years and have capsular contracture (grade 3) on one side. Chance of reoccurance?

Answers (9)

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